a study of safety and efficacy of fibrin sealant grifols as an adjunct to haemostasis during surgery in paediatric participants

Conditions: Excessive Bleeding During Surgery

Summary: the objective of the study is to evaluate if fs grifols is non-inferior to evicel® in terms of the percentage of participants achieving hemostasis at the target bleeding site (tbs) by 4 minutes (t4) from the start of treatment application (tstart) with no occurrence of rebleeding until the completion of the surgical closure by layers of the exposed surgical field containing the tbs (tclosure).

this is a prospective, randomized, active-controlled, single-blind, parallel group clinical trial to evaluate the safety and efficacy of fs grifols as an adjunct to hemostasis during surgery. approximately 172 pediatric participants will be enrolled and will be randomly allocated in a 1:1 ratio into 1 of 2 treatment groups: fs grifols or evicel. enrollment will be monitored by surgery type to ensure at least 50% of the surgical procedures are hepatic. a specific bleeding site will be defined as the tbs when it is determined by the investigator (the surgeon) that control of bleeding by conventional surgical techniques (including suture, ligature, and cautery) is ineffective or impractical and requires an adjunct treatment to achieve hemostasis. when the tbs is identified, the investigator will record the precise anatomical location of the tbs, rate the intensity of the bleeding at the tbs (grade 1-4 according to a 5-point validated bleeding severity scale), and record the size of the approximate bleeding surface, (small, medium, and large). for soft tissue surgery only, the investigator will also record the type of soft tissue (ie, fat, muscle, or connective tissue). in this clinical trial, only participants with a tbs with bleeding of grade 1 (mild) or grade 2 (moderate) intensity will be enrolled. this study includes a screening visit to determine participant eligibility, a baseline visit, the surgical procedure (day 1), and post-operative assessments at days 1, 4, and 30. the total duration of a participant's participation in this study is expected to be no longer than 2 months from the screening visit to the post-operative day 30 visit.

Eligibility criteria:
inclusion criteria: pre-operative: 1. less than 18 years of age. 2. requires an elective (non-emergent), open (non-laparoscopic), pelvic, abdominal, or thoracic (non-cardiac) surgical procedure. 3. participant and/or participant's legal guardian is willing to give permission for the participant to participate in the clinical trial and provide written informed consent for the participant. in addition, assent must be obtained from pediatric participants who possess the intellectual and emotional ability to comprehend the concepts involved in the clinical trial. intra-operative: 4. presence of an appropriate (as defined in inclusion criterion 5) parenchymous or soft tissue tbs identified intra-operatively by the investigator (the surgeon). 5. tbs has grade 1 (mild) or grade 2 (moderate) bleeding intensity according to the investigator's (the surgeon's) judgment. the intensity of the bleeding at the tbs will be rated by the investigator using the 5-point validated bleeding severity scale. exclusion criteria: pre-operative: 1. admitted for trauma surgery. 2. unwilling to receive blood products. 3. known history of severe (eg, anaphylactic) reaction to blood products. 4. known history of intolerance to any of the components of the investigational product (ip). 5. female participants who are pregnant, breastfeeding or, if of child-bearing potential (ie, adolescent), unwilling to practice a highly effective method of contraception. 6. previously enrolled in a clinical trial with fs grifols. 7. currently participating, or during the study is planned to participate, in any other investigational device or medicinal product study without prior and explicit approval from the sponsor. intra-operative: 8. an appropriate parenchymous or soft tissue tbs (as defined in exclusion criteria 9 and 10) cannot be identified intra-operatively by the investigator (the surgeon). 9. tbs has grade 3 (severe) bleeding according to the investigator's (the surgeon's) judgment that cannot be controlled with conventional surgical techniques to grade 1 or grade 2 bleeding. the intensity of the bleeding at the tbs will be rated by the investigator using the 5-point validated bleeding severity scale. 10. tbs is in an actively infected surgical field. 11. occurrence of major intra-operative complications that require resuscitation or deviation from the planned surgical procedure. 12. application of any topical hemostatic agent on the resection surface of parenchyma or soft tissue prior to application of the ip.